Democrats are using smoke and mirrors to hide the impact of
their health plans. Existing estimates, therefore, reflect only a
fraction of the total cost. With a little hustle, however, fiscally
responsible members of Congress can bring the full costs to
light.

First, Congress should ensure that the nonpartisan Congressional
Budget Office includes all new state and private-sector spending,
as well as new federal spending, in the total cost of each
bill.

In 2006, Massachusetts snuck a health care boondoggle past the
voters by pushing 20 percent of the cost on to the federal
government and 60 percent onto private individuals and employers,
according to data from the Massachusetts Taxpayers Foundation.

President Barack Obama’s plan would commit states to increase
Medicaid spending (governors are furious) and require individuals
and employers to spend more on health insurance (Obama’s top
economist, Larry Summers, says those mandates “are like public
programs financed by benefit taxes”).

The CBO should include all such costs (including any additional
coverage that already insured Americans would be forced to
purchase) in the total-cost figure for each bill.

Second, with those totals in hand, the CBO should assume that
all new spending would be fully implemented in 2010, and then
calculate the 10-year cost from that baseline.

House Democrats kept the (on-budget) cost of their plan to a
mere $1.2 trillion by delaying implementation until the second half
of the 10-year budget window.

It’s an age-old budget gimmick that makes huge new programs
appear smaller. Assuming immediate implementation would reveal the
(on-budget) cost of the House plan to be 50 percent greater than
current projections suggest.

Third, the CBO should calculate the cost of covering each
previously uninsured person.

It costs Massachusetts about $6,700 to cover each previously
uninsured resident, or about $27,000 to cover a family of four.
Democrats should justify why they want to tax us that much when the
average employer-sponsored family policy costs just $12,680.

Fourth, the CBO should conduct a “Ryan score” for each health
reform bill, so named for Rep. Paul Ryan (R-Wis.).

The CBO projects that under current law, federal spending will
grow from 20 percent of the economy today to nearly 40 percent by
the end of this century, mainly because of Medicare and
Medicaid.

At the request of Ryan, the CBO estimated that federal
income-tax rates would nearly have to double by midcentury (top
rate: 66 percent) and more than double by 2082 (top rate: 88
percent), just to pay for those existing federal commitments.

Americans deserve to know whether Obama’s plan would push tax
rates higher than 66 percent. The CBO fulfilled Ryan’s original
request in just four days. That doesn’t seem too long to wait
before mortgaging your children’s future.

Finally, the CBO should estimate whether the insured would be
winners or losers under individual and employer mandates.

The Urban Institute estimates that cost-shifting from the
uninsured increases private insurance premiums by “at most 1.7
percent.” Supporters claim that individual and employer mandates
would benefit the insured by reducing cost-shifting.

But mandates also require already insured people to pay higher
taxes to help others buy insurance. As in Massachusetts, many
already insured people would have to pay higher premiums to comply
with the mandate. The 180 million Americans with private insurance
deserve to know whether those mandates would actually save them
money.

As our third president wrote to our first president, “Delay is
preferable to error.” Congress should not vote on health reform
until the American people have all the facts.